Language assistance now a reality for limited-English speaking California HMO members

New state program will guarantee interpretive services in doctors’ offices and clinics

(Sacramento) -- For the first time, California HMO members with limited English-speaking ability will be able to easily communicate with their health plan providers. New state regulations developed by the California Department of Managed Health Care (DMHC) will ensure that all health plan members understand what their prescriptions are used for or what they need to do to follow doctor's orders, without having to rely on their children or other family members as interpreters.

“In today’s complex medical world, it is crucial that patients understand the instructions given by their doctors, which can be difficult if there is a language barrier,” said Cindy Ehnes, Director of the DMHC. “These new regulations will allow millions of Californians with limited or no English-speaking ability to have equal access to health care treatment.”

The DMHC regulations fully implement SB 853, authored by former Senator Martha Escutia (D-Montebello), which requires California health plans to set up a system where services, materials, and information are provided to members in a language that they speak and understand.

According to the 2000 census, almost 40 percent of Californians speak a language other than English at home. During the time when the legislation was passed, Senator Escutia’s office reported that more than 70 percent of health care providers surveyed indicated that language barriers make it harder for patients to explain their symptoms and affect their understanding of treatment advice.

Data compiled by the UCLA Center for Health Policy Research, and sponsored by the Office of the Patient Advocate, illustrate the need for language assistance within California’s HMO membership. A sampling of HMO members shows that of those who receive their care through private health insurance, 594,000 adult members (7.2%) reported that they speak no English at home, and 759,000 members (9.2%) reported that they have limited Englishproficiency (LEP).

“Even among insured Californians, language barriers posed enormous barriers to access to health care,” said Alicia Fernandez, Associate Professor of Medicine for UCSF, and author of the study “The Impact of Race/Ethnicity and Language on Access and Experience of Care Among California’s Insured Adults. “Nearly one in four enrollees who speak limited English experience delays in getting care. English language proficiency, in addition to race/ethnicity, should be among the factors used to assess health care quality.”

“We are proud of our work to change the rules in California so that our families and friends can understand their doctors and health plan information,” said Ellen Wu, MPH, Executive Director of the California Pan-Ethnic Health Network (CPEHN), sponsor of SB 853. “Because of these new requirements, a health plan will be accountable for providing quality services to its diverse members. This program is a model for the rest of the country.”

The regulations will require each of the 100 full-service and specialty health care plans (e.g. dental, vision) under the DMHC’s jurisdiction to develop and implement its own language assistance program. In addition to language assistance, health plans will be required to translate such things as:

Standard letters and notices of insurance eligibility and membership requirements

Notices of any denial, reduction, modification, or termination of services and benefits

Notices of the right to file grievances or appeals

The California Department of Managed Health Care is the only stand-alone HMO watchdog agency in the nation, touching the lives of more than 20 million enrollees. The DMHC has assisted more than 633,000 Californians to resolve their HMO problems through its 24-hour HMO Help Center, educates consumers on health care rights and responsibilities, and works closely with HMO plans to ensure a solvent and stable managed health care system